Return to activities of daily living in adults after periacetabular osteotomy: a systematic review

Abstract Periacetabular osteotomy (PAO) is an established surgical intervention for symptomatic acetabular dysplasia. While outcomes are traditionally assessed through patient-reported outcome measures (PROMs), the broader impact on return to activities of daily living (ADLs) remains underexplored. This systematic review aims to synthesize existing literature on post-PAO recovery beyond conventional PROMs, focusing on occupational reintegration, return to sports, driving, sexual function, and social participation. A systematic search of MEDLINE, Embase, and MEDLINE databases was conducted, identifying studies reporting on ADL outcomes following PAO. Thematic analysis was used to categorize and synthesize data across diverse domains due to heterogeneity in study designs and outcomes measures. Eleven eligible studies were identified. PAO generally supports favourable recovery across multiple ADLs. Patients typically return to work and sports, though modifications in role or activity type are common. Return to sports outcomes vary by baseline athletic level, with competitive athletes facing greater challenges. Sexual health improvements are frequently linked to pain reduction, though outcomes are often variable. Limited evidence suggests temporary impairments in driving function, while broader improvements in social engagement and quality of life are evident over time. However, research across these domains remains limited and inconsistent in outcome definition. Beyond biomechanical correction, PAO impacts diverse aspects of daily life. A more holistic understanding of recovery, integrating ADL and psychosocial outcomes, is essential for optimizing patient counselling and care. Future research should prioritize standardized definitions, long-term follow-up, and the use of novel tools to assess real-world function.